Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis

Blinder, Henrietta; Momoli, Franco; Bokhaut, Julia; Bacal, Vanessa; Goldberg, Reuben; Radhakrishnan, Dhenuka; Katz, Sherri L.

doi:10.1016/j.sleep.2019.12.015

Cited by 25 publications

(13 citation statements)

References 56 publications

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“…While low, this adherence rate is similar to that reported in children prescribed non-invasive ventilation. 39 It will be necessary to further explore the reasons behind the low LVR adherence rates, as LVR likely still has an important role in assisting airway clearance during pulmonary exacerbations in this population, when pulmonary function may be expected to be reduced, as well as for preservation of chest wall compliance.…”

Section: Discussionmentioning

confidence: 99%

Routine lung volume recruitment in boys with Duchenne muscular dystrophy: a randomised clinical trial

Katz

Mah

McMillan

et al. 2022

Thorax

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BackgroundImpaired cough results in airway secretion retention, atelectasis and pneumonia in individuals with Duchenne muscular dystrophy (DMD). Lung volume recruitment (LVR) stacks breaths to inflate the lungs to greater volumes than spontaneous effort. LVR is recommended in DMD clinical care guidelines but is not well studied. We aimed to determine whether twice-daily LVR, compared with standard of care alone, attenuates the decline in FVC at 2 years in boys with DMD.MethodsIn this multicentre, assessor-blinded, randomised controlled trial, boys with DMD, aged 6–16 years with FVC >30% predicted, were randomised to receive conventional treatment or conventional treatment plus manual LVR twice daily for 2 years. The primary outcome was FVC % predicted at 2 years, adjusted for baseline FVC % predicted, age and ambulatory status. Secondary outcomes included change in chest wall distensibility (maximal insufflation capacity minus FVC) and peak cough flow.ResultsSixty-six boys (36 in LVR group, 30 in control) were evaluated (median age (IQR): 11.5 years (9.5–13.5), median baseline FVC (IQR): 85% predicted (73–96)). Adjusted mean difference in FVC between groups at 2 years was 1.9% predicted (95% CI −6.9% to 10.7%; p=0.68) in the direction of treatment benefit. We found no differences in secondary outcomes.ConclusionThere was no difference in decline in FVC % predicted with use of twice-daily LVR for boys with DMD and relatively normal lung function. The burden associated with routine LVR may outweigh the benefit. Benefits of LVR to maintain lung health in boys with worse baseline lung function still need to be clarified.Trial registration numberNCT01999075.

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Section: Discussionmentioning

confidence: 99%

Routine lung volume recruitment in boys with Duchenne muscular dystrophy: a randomised clinical trial

Katz

Mah

McMillan

et al. 2022

Thorax

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“…Meta-analysis calculations were added for 11 factors, and we added 11 articles published after 2019 that were not included in the previous systematic review. 12 After including more studies in the present meta-analysis, we found significant results in regard to age, BMI, and AHI on CPAP adherence in children with OSA ( Figures 2 , 5 and 9 ) and nearly significant results regarding sex with a 95% CI of 0.46, 1.00 ( Figure 3 ). The previous meta-analysis was unable to declare significance in regard to age (not performed), BMI (difference −0.14; 95% CI: −0.47, 0.19), or AHI (difference 4.32; 95% CI: −0.61, 9.26).…”

Section: Discussionmentioning

confidence: 68%

“… 25 , 43 Finally, this present study included only published articles, unlike the previous report, which included abstract articles. 12 …”

Section: Discussionmentioning

confidence: 99%

“…Another meta-analysis on this topic published in 2020 with the final search in 2019 identified five factors calculated as predictors of CPAP adherence in children with OSA. 12 Studies conducted on non-invasive ventilator or a randomized controlled trial were included, resulting in an ability to report the CPAP adherence rate for children with OSA. 13 , 14 Additionally, the adherence rate was not reported.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to Continuous Positive Airway Pressure Therapy in Pediatric Patients with Obstructive Sleep Apnea: A Meta-Analysis

Sawunyavisuth

Ngamjarus

Sawanyawisuth

2023

TCRM

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Introduction Obstructive sleep apnea (OSA) is a public health problem that affects children. Although continuous positive airway pressure (CPAP) therapy is effective, the CPAP adherence rate in children is varied. This study aimed to evaluate the CPAP adherence rate and factors associated with CPAP adherence in children with OSA using a systematic review. Methods The inclusion criteria were observational studies conducted in children with OSA and assessed adherence of CPAP using objective evaluation. The literature search was performed in four databases. Meta-analysis using fixed-effect model was conducted to combine results among included studies. Results In all, 34 studies that evaluated adherence rate and predictors of CPAP adherence in children with OSA were included, representing 21,737 patients with an average adherence rate of 46.56%. There were 11 calculations of factors predictive of CPAP adherence: age, sex, ethnicity, body mass index, obesity, income, sleep efficiency, the apnea-hypopnea index (AHI), severity of OSA, residual AHI, and lowest oxygen saturation level. Three different factors were linked to children with adherence and non-adherence to CPAP: age, body mass index, and AHI. Conclusion The CPAP adherence rate in children with OSA was 46.56%. Young age, low body mass index, and high AHI were associated with acceptable CPAP adherence in children with OSA.

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“…Four published comprehensive reviews of the literature (Blinder et al, 2020; Sawunyavisuth et al, 2021; Sawyer et al, 2011; Watach, Xanthopoulos, Afolabi-Brown, Saconi, Fox, et al, 2020) and a recently published book chapter (Watach, Xanthopoulos, Afolabi-Brown, Saconi, & Sawyer, 2020) were utilized to identify factors impacting adherence to PAP. A further review of the literature was conducted for studies completed following the publication of the most recent scoping review.…”

Section: Methodsmentioning

confidence: 99%

An overview and application of evidence-based interventions to improve adherence to positive airway pressure for the treatment of pediatric obstructive sleep apnea.

Levert¹,

Maniaci²,

Tapia³

et al. 2022

Clinical Practice in Pediatric Psychology

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Objective: The purpose of this manuscript is to provide an overview of evidence-based strategies designed to promote adherence to and self-management of positive airway pressure (PAP) for the treatment of pediatric obstructive sleep apnea syndrome (OSAS) with an emphasis on those who are disproportionately impacted by OSAS. Methods: Utilized four recently published review articles and a book chapter, as well as a search of the literature since the most recent scoping review was published, to identify factors impacting pediatric adherence to PAP. Proposed conceptual models for self-management and adherence were also evaluated and strategies addressing factors within the context of these models were reviewed for application. Results: Evidence-based cognitive-behavioral strategies within a bio-socioecological framework and interdisciplinary team-based model are presented. A case study highlights the application of these interventions using an interdisciplinary coordinated care model, including clinical outcome data (e.g., objective adherence measures from the PAP device). Conclusions: Existing evidence supports a family-centered interdisciplinary approach to initiating PAP and supporting long-term PAP adherence for the treatment of pediatric OSAS. A bio-socioecological framework provides structure for assessment and flexibility in which interventions, such as education, cognitive-behavioral strategies, and social support, can be tailored to the unique needs of each child and family. Implications for Impact StatementStarting and regularly using positive airway pressure (PAP) for the treatment of obstructive sleep apnea syndrome (OSAS) in children is challenging due to an interplay of medical, developmental, behavioral, social, interpersonal, and technical factors. Assessment of these factors and identification of specific challenges for an individual child and their family can provide a framework in which evidence-based strategies can be applied to improve the initiation and long-term use of PAP. Education, cognitivebehavioral strategies, and social support provided by an interdisciplinary team can be tailored to the unique needs of each child and family to facilitate acceptance and longterm use of this efficacious treatment. Melissa S. Xanthopoulos https://orcid.org/0000-0003-4093-0539 Melissa S. Xanthopoulos reports grant support from the

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Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis

Cited by 25 publications

References 56 publications

Routine lung volume recruitment in boys with Duchenne muscular dystrophy: a randomised clinical trial

Routine lung volume recruitment in boys with Duchenne muscular dystrophy: a randomised clinical trial

Adherence to Continuous Positive Airway Pressure Therapy in Pediatric Patients with Obstructive Sleep Apnea: A Meta-Analysis

An overview and application of evidence-based interventions to improve adherence to positive airway pressure for the treatment of pediatric obstructive sleep apnea.

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